Men's fertility and cancer treatment

Sunday 1 May, 2016

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On this page: Chemotherapy | Radiotherapy | Surgery | Hormone therapy | Other treatments | Avoiding pregnancy during treatment | Key points

Related pages: Men's options before cancer treatment | Men's options after cancer treatment


This section provides an overview of how cancer treatments affect men’s fertility. The most common treatments for cancer are chemotherapy, radiotherapy, surgery and hormone therapy.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. These are called cytotoxic drugs. Chemotherapy drugs kill fast-growing cells such as cancer cells. The drugs can also affect other cells that grow quickly, such as the reproductive cells.

In men, chemotherapy may reduce or stop the production of sperm. The drugs may also affect the ability of the sperm to move up the fallopian tubes (motility) and alter the sperm’s genetic make-up.

The risk of infertility depends on several factors:

  • the type of chemotherapy drug/s used – damage to sperm production is more common with drugs in the alkylating class
  • the dose and duration of chemotherapy treatment – this will affect how long it takes sperm production to return; in some cases, it may stop. It may start again, but this often takes several years. For some men, sperm production can take up to a decade to improve or it may be permanent.
  • your age – less likely to recover your fertility if you are over 40.

Chemotherapy can cause permanent infertility if the cells in the testicles are too damaged to produce healthy, mature sperm again.

To find out more see Understanding Chemotherapy  or call Cancer Council 13 11 20.

Radiotherapy

Radiotherapy (also called radiation therapy) uses x-rays to kill cancer cells or damage them so they cannot grow and multiply. It can be delivered externally by external beam radiation, or given internally.

The risk of infertility depends on the area treated, the dose (measured in grays) and the number of treatments.

  • External radiotherapy to the pelvic area for prostate, rectal, bladder or anal cancer and some childhood leukaemias may affect sperm production.
  • Radiotherapy to the brain may damage the area that controls hormone production (pituitary gland), which affects the production of sperm and affects sex drive.
  • Brachytherapy seed implants used for testicular cancer may affect sperm production, but most men recover.
To find out more about see Understanding Radiotherapy or call Cancer Council 13 11 20.

Surgery

Surgery aims to remove the cancer from the body. If surgery removes part or all of a sex organ or if it removes organs in the surrounding area (such as the bladder), your ability to conceive a child will be affected.

Removal of the testicles (orchidectomy) – After having one testicle removed (orchidectomy), the remaining testicle will make enough sperm for you to father a child, unless the sperm is unhealthy. If the remaining testicle doesn’t produce enough testosterone, you can have hormone replacement therapy (supplements) to stimulate sperm production.

In some rare cases, both testicles are removed (bilateral orchidectomy). This causes permanent infertility because you will no longer produce sperm. You will still be able to get an erection.

Removal of the prostate (prostatectomy) – During surgery to remove the prostate gland and seminal vesicles, the vas deferens are cut, so the semen cannot travel from the testicles to the urethra.

The impact of the operation on erections depends on the quality of your erections before surgery. You may still have erections and the pleasurable feelings of orgasm, but no longer ejaculate semen during climax (dry orgasm), or semen may go backwards towards the bladder instead of forwards (retrograde ejaculation). See below for more details.

Removal of lymph glands (retroperitoneal lymph node dissection or lymphadenectomy) – Surgery for bladder, prostate or testicular cancer may damage the nerves used for getting and keeping an erection (erectile dysfunction). This may last for a short time or be permanent.

It may be possible for the surgeon to use a nerve-sparing surgical technique to protect the nerves that control erections. This works best for younger men who had good quality erections before the surgery. Problems with erections are common for 1–3 years after nerve-sparing surgery.

Managing side effects of surgery

Dry orgasm – If you are experiencing a dry orgasm, you will not be able to father a child through sexual intercourse. However, it may be possible to have testicular sperm extraction.

Retrograde ejaculation – To manage this side effect of surgery, you may be given medicine to contract the internal valve of the bladder. This forces the semen out of the penis, as normal, and it may make it possible for you to conceive naturally.

Erectile dysfunction – Having difficulty getting and maintaining an erection is known as erectile dysfunction or impotence. Before treatment, your doctors will discuss whether you are likely to have nerve damage that causes this problem. Medicine or aids can help to restore the ability to get and keep an erection.

To find out more see Understanding Surgery or call Cancer Council 13 11 20. 

Hormone therapy

Hormones that are naturally produced in the body can cause some types of cancers to grow. The aim of hormone therapy is to reduce the amount of hormones the tumour receives to help slow down the growth of the cancer.

In men, testosterone helps prostate cancer grow. Slowing the body’s production of testosterone and blocking its effects may slow the growth of the cancer or even shrink it. This may cause infertility. Men with breast cancer who are taking the drug tamoxifen (an anti-oestrogen drug) may experience increased sperm production.

Other treatments

Other treatments for cancer include stem cell transplants, immunotherapy and targeted therapies.

Stem cell transplants often require high doses of chemotherapy and, possibly, radiotherapy. This is given before the transplant to destroy cancer cells in the body and weaken the immune system so that it will not attack a donor’s cells during the transplant. High-dose chemotherapy or radiotherapy can permanently affect sperm production.

The effects of immunotherapy and targeted therapies on fertility and pregnancy are not yet known. It is important to discuss your fertility options with your cancer or fertility specialist.

Avoiding pregnancy during treatment

Some cancer treatments, such as chemotherapy or radiotherapy, may harm an unborn baby or cause birth defects. As you might be fertile during treatment, you will need to use contraception or practise abstinence to avoid conceiving during treatment.

Key points

  • Chemotherapy is drug treatment that can damage sperm. Sperm production may reduce or stop, and it can take years to resume.
  • Radiotherapy, given externally or internally, may damage the reproductive organs or the pituitary gland, which makes hormones to trigger sperm production.
  • Surgery to the reproductive organs or surrounding area may affect sperm production, and the ability to get an erection and ejaculate.
  • Other treatments, including hormone therapy and stem cell transplants, can also have an impact on fertility.
  • You will be advised to avoid conceiving during cancer treatment and for a period of time afterwards.  

Reviewers: Prof Roger Hart, Medical Director of Fertility Specialists of Western Australia and Professor of Reproductive Medicine, School of Women’s and Infant Health, University of Western Australia, WA; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s and Prince of Wales Hospitals, Director of the Sydney Youth Cancer Service, NSW; Brenda Kirkwood, 13 11 20 Consultant, Cancer Council Queensland, QLD; Dr Michael McEvoy, Director of Clinical Services, Flinders Fertility, SA; Eden Robertson, Research Officer, Behavioural Sciences Unit, Sydney Children’s Hospital, NSW; Kayla Schmidt, Consumer; A/Prof Kate Stern, Head of Fertility Preservation Service, The Royal Women’s Hospital and Melbourne IVF, Head Endocrine and Metabolic Service, Royal Women’s Hospital and Clinical Director, Melbourne IVF, VIC; and Prof Jane Ussher, Centre for Health Research, Western Sydney University, NSW.